Thoracic Aortic Diseases

Illustration of the heart and aorta

The aorta is the largest artery in the human body and is connected to the left ventricle of the heart. It sends the blood pumped by the heart through many branches that carry blood to all of the organs of the body. Aortic diseases can affect people at any age. They are complex illnesses that must be continually monitored.

Patients with aortic disease usually have no symptoms and are unaware of the changes in their aorta.  Often, the diagnosis is made incidentally through imaging tests such as chest X-rays, CT scans, or echocardiograms performed for other reasons.

The wall of the aorta can become weakened for a variety of reasons, and the weakened  section may become enlarged. This enlargement or dilatation, known as a thoracic aortic aneurysm, can develop slowly over many years. Like an inflated balloon, the wall of the aorta becomes thin and can tear (dissect) or rupture when it is stretched by an aneurysm. 

In the event of an aortic dissection, the wall of the aorta tears causing blood to flow through the tear into the inner layers of the aortic wall, pushing them apart and reducing blood flow to the rest of the body. An aortic dissection or rupture requires immediate surgical repair.

Causes 

The causes of aortic diseases include:

  • Hardening of the arteries (atherosclerosis), which is more common in people with high cholesterol, high blood pressure and those who smoke
  • Connective tissue disorders (e.g., Marfan’s syndrome)
  • Inflammation of the aorta
  • Birth defects (e.g., bicuspid aortic valve)
  • Genetic predisposition

 

Symptoms 

Most aortic aneurysms do not cause symptoms, but symptoms may include:

  • Chest Pain
  • Back Pain
  • Hoarseness of the voice
  • Swallowing problems
  • High-pitched breathing (stridor)

Symptoms of a ruptured aortic aneurysm include:

  • Severe chest or back pain
  • Loss of consciousness
  • Nausea/vomiting
  • Low blood pressure
  • Rapid heart rate
Symptoms of Thoracic Aorta Diseases: High-pitched breathing (stridor), Hoarseness of the voice, Swallowing problems, Chest Pain (may be severe), Low blood pressure, Back Pain, Loss of consciousness, Nausea/vomiting

Click to enlarge

Diagnosis 

Aortic aneurysms can be diagnosed and monitored using imaging techniques including computed tomography (CT) scans, echocardiograms, or magnetic resonance imaging (MRI). Once it is confirmed that the aorta is enlarged or an aneurysm exists, routine imaging tests (i.e., CT scans or echocardiograms) are used to monitor the progress of the disease. If the size of the aorta continues to grow, your physician will discuss the options to repair the aorta.

Treatment 

Lifestyle Changes

It is important for patients with aortic aneurysms to control the risk factors that can make the condition worse. Smoking and high blood pressure are the greatest concerns:

  • Smokers must quit smoking. Patients may be referred to the Heart Institute Quit Smoking Program. A variety of aids and support are available to help with the quitting process.
  • Blood pressure must be kept within normal limits. Adjustment of medications, a low sodium diet and exercise can achieve this. Patients should avoid heavy lifting and highly physical activities.

Aortic Clinic

Patients referred to the  Aortic Clinic are seen in consultation with a cardiac surgeon, a cardiologist and a registered nurse. A thorough individualized assessment of the risk of complications is performed and a plan of care is determined, including imaging studies and follow-up appointments. Patients may be managed medically or surgically, depending on their situation.

For patients needing a surgical repair of the aorta, discussions will cover the surgical procedure, preparation for surgery, and the hospital stay. Following discharge, patients are seen in the clinic by the surgeon. The next follow up visit will be arranged with the Clinic.

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